HomeMy Public PortalAbout6124 SAINT JAMES DR_Sewer_8/31/1965_ DEEDED 1
TE80aAPPLICATION FOR PER IT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILOIN
IOtSN A LAMS County Fagmppa ADORES
1.0
WIL I A JENSEN Sup t o! Hutldma
OCALITY
NEAREST
FOR APPUC TO FII.L IN `ROSE BY
Dip<RIRTION LOT NO OWNER
MAIL
BLOCK TRACTADORES[
09
pN OR SEGOS
SIZE OF LOT NOW ON LOT CITY TEL NO
BUILDINGS
OP t DISTRICT NO OROU NOK AR po PROCESSED BY
EUILOIXOE
CONTRACTD S;A� S5R
ADDRESSY r CONNEC7lON RASA
aSTATIOH DEPTH
CITY TEL �
STATE UPPER
REGISTRATION NO COUNTY MANHOLE REFERENCE
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LEND"FROM
HOUSE SEWER CONNECTING TO Y CURE P ML TO P L }
FUELED 8[W CR pp 00
pSL C TANK SEEPAGE PIT OI1 P C NO Q.
PITS AND/OR GRAINFIELD Q flow CO IMF NO JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM SE Go
CONNECT ADDITIONAL SLOG OR AFFIDAVIT WAIVER waplli RECORD INETR NO DAT[ O
WORK TO MOUSE SEWER O fE00
OVERFLOW SEEPAGE PIT DRAINFIELO
EXTN CESSPOOL DRYW[LL MANHOLE 4 Ep OO d
ALTER R PAIR ON ABANDON MOUS! HWY OR ST WIDENING N
SEWER OR DIEPOSALSYSTEM [E OO STATE ENCROACH MINT Z_
PERMIT NO
INDUSTRIAL
WAST[APPROVAL
CHARGES
OWNER'S PERMIT s x 00
CONNECTION CHARGER[[
AUTHORIZATION I TOTAL PEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEITCOMPLY
REIMBURSEMENT FE!
TRACTOR TO CONNECT THE ABOVE DESCRIBEDAPPROVAL$
TO THE PUBLIC SEWER GATE INNECTORBSIGNATURE
SIGNED THIS DAY Owls—
TO
N[W HOUSE SEWER
OWN NS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADOR[iS
1 HEREBY ACKNOWLEDGE THAT I HAVE READ AND/OR
TANK SEEP PIT(S)
AND STAT[ THAT THE ABOVE 1E CORRECT AND Y AXD�OR pRA1NFl[LDWITH ALL COUNTY ORDINANCES AND STATE L
FLU M'INO AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HERESY21RIOA
Y THAT 1 AM PROPERLY REGI ERSD AND/OR ALTER REPAIR SEWEROR
LICCNBED BY L/ LCE C NTY AND STAT[ OF EEWAG[OISPOEAL SYSTEM
CALIFOR TI M TMOW R OF AND INTEND TO DISCONNECT PLUG AND
ESIDE OVE
OV
DEBCRI [pl TIA ROFERTY
ABANDON HOUSE SEWER
SI ONA U BACKFILL SE1��IC TANKS ❑
OF BEEP
PIT LJ CCSEPOOLS
VALIDATION^ ROBERT A WOOD
N o AA,S�M/J SUPERVISING MECHANICAL ENGINEER
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